Recent studies have indicated that the expression of ubiquitin-specific protease 51 (USP51), a novel deubiquitinating enzyme (DUB) that mediates protein degradation as part of the ubiquitin‒proteasome system (UPS), is associated with tumor progression and therapeutic resistance in multiple malignancies. However, the underlying mechanisms and signaling networks involved in USP51-mediated regulation of malignant phenotypes remain largely unknown. The present study provides evidence of USP51's functions as the prominent DUB in chemoresistant triple-negative breast cancer (TNBC) cells. At the molecular level, ectopic expression of USP51 stabilized the 78 kDa Glucose-Regulated Protein (GRP78) protein through deubiquitination, thereby increasing its expression and localization on the cell surface. Furthermore, the upregulation of cell surface GRP78 increased the activity of ATP binding cassette subfamily B member 1 (ABCB1), the main efflux pump of doxorubicin (DOX), ultimately decreasing its accumulation in TNBC cells and promoting the development of drug resistance both in vitro and in vivo. Clinically, we found significant correlations among USP51, GRP78, and ABCB1 expression in TNBC patients with chemoresistance. Elevated USP51, GRP78, and ABCB1 levels were also strongly associated with a poor patient prognosis. Importantly, we revealed an alternative intervention for specific pharmacological targeting of USP51 for TNBC cell chemosensitization. In conclusion, these findings collectively indicate that the USP51/GRP78/ABCB1 network is a key contributor to the malignant progression and chemotherapeutic resistance of TNBC cells, underscoring the pivotal role of USP51 as a novel therapeutic target for cancer management.

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

Objective:To establish a time control mode for component blood collection and to discuss its application value in the operation management of blood separator.Methods:The causes for delay in blood separation time in blood component collection were analyzed,the correlation between influencing factors and time control level was analyzed by using data mining algorithm,and time control management countermeasures were developed by running time prediction.A total of 600 blood donors and 17 blood separators in clinical use in Shanghai Xuhui District Central Hospital from 2019 to 2022 were selected and divided into a control group(300 blood donors,14 blood separators)and an observation group(300 blood donors,15 blood separators,including 12 of control groups and 3 newly added)according to different management modes.The control group adopted the quality control mode,the observation group adopted the time control mode.The number of problems,the proportion of delay,the number of satisfied people and the assessment results of relevant medical staff in the blood component collection process were compared between the two groups.Results:The number of blood donors with problems related to equipment,medical consumables,medical staff and blood donors during the blood component collection process in the observation group was 11(accounting for 3.7%),17(accounting for 5.7%),7(accounting for 2.3%)and 18(accounting for 6.0%),respectively,which were lower than those in the control group,the difference was statistically significant(x2=7.192,6.822,8.153,11.405,P<0.05).The number of blood donors whose blood separators were in normal operation,apparent delay and significant delay in the observation group were 236(accounting for 78.7%),46(accounting for 15.3%)and 18(accounting for 6.0%),respectively,and the proportions of normal operation were higher than those in the control group,the proportions of apparent delay and significant delay were lower than those in the control group,the difference was statistically significant(x2=17.821,7.131,8.549,P<0.05).The proportion of blood donors satisfied was 284(accounting for 94.7%)in the observation group,which was higher than that in the control group,the difference was statistically significant(x2=30.171,P<0.05).The assessment score of medical staff involved in blood donors in the observation group was(91.14±4.86),which was higher than that in the control group,the difference was statistically significant(t=4.587,P<0.05).Conclusion:Time control mode can control the probability of the problems in the operation of blood separator,shorten the delay time of blood separator operation,improve blood donation experience of blood donors and blood collection service quality,and improve the professional level of medical staff.

Objective To investigate the correlation between serum Sortilin(SORT)and insulin-like growth factor 1(IGF-1)levels and the occurrence and prognosis of cardiovascular disease(CVD)in maintenance hemodialysis(MHD)patients with end-stage renal disease(ESRD).Methods Eighty-four MHD patients with ESRD diagnosed and treated in the First People's Hospital of Kunshan from February 2017 to February 2018 were selected as the MHD group.With 5 years of follow-up,the MHD group was divided into the CVD group(n=35)and the non-CVD group(n=49)according to whether they had concurrent CVD,while 60 healthy individuals who underwent physical examination during the same period were used as the control group.Enzyme-linked immunosorbent assay was used to detect serum SORT and IGF-1 levels.Multivariate logistic regression analysis was conducted to investigate the influencing factors of CVD in MHD patients with ESRD.The predictive value of serum SORT and IGF-1 for CVD in MHD patients with ESRD was analyzed by the receiver operating characteristic curve.The correlation between serum SORT and IGF-1 levels and the survival rate of MHD patients with ESRD was analyzed by Kaplan-Meier survival analysis.Results Compared to the control group,the MHD group had higher serum SORT level(413.37±55.41 ng/L vs 81.27±24.69 ng/L)and lower serum IGF-1 level(117.64±18.42 μg/L vs 421.34±14.58 μg/L),with significant differences(t=43.416,106.122,all P＜0.001).The age,dialysis time,and serum SORT level(488.73±55.41ng/L vs 359.54±58.29ng/L)of patients in the CVD group were higher than those in the non-CVD group,while serum IGF-1 level(88.25±17.92 μg/L vs 138.63±19.55μg/L)was lower than that of the non-CVD group,with significant differences(t=2.896,2.588,10.221,12.050,all P＜0.05).Age(OR=1.548,P＜0.001),dialysis time(OR=1.616,P＜0.001)and serum SORT(OR=1.353,P＜0.001)were independent risk factors for CVD in MHD patients,while serum IGF-1(OR=0.742,P=0.000)was a protective factor for CVD in MHD patients.The area under the curve(95％CI)of the combined serum SORT and IGF-1 test for predicting concomitant CVD in MHD patients was 0.931(95％CI:0.895～0.961),which was greater than that of the single detection[0.843(0.810～0.889),0.887(0.833～0.921)],and the differences were statistically significant(Z=5.117,4.895,all P＜0.001).The five-year cumulative survival rate of MHD patients in the SORT high expression group(48.39％)was lower than that in the low expression group(84.81％),while the five-year cumulative survival rate of MHD patients in the IGF-1 low expression group(51.52％)was lower than that in the high expression group(84.31％),and the differences were significant(Log-Rank x2=18.670,8.900,all P＜0.01).Conclusion The serum SORT levels increased while IGF-1 levels decreased in MHD patients.The combined detection of the two has high predictive value for the occurrence of CVD in MHD patients with ESRD,which is associated with poor survival prognosis in MHD patients with ESRD.

Objective To analyze the incidence and mortality of pancreatic cancer in 2022 globally and in China based on the Global Cancer Statistics 2022 published by the International Agency for Research on Cancer,considering characteristics such as gender,age,and human development index(HDI).Methods Pancreatic cancer data from 185 countries and regions were sourced from the GLOBOCAN 2022 database,and HDI data were compiled based on the Human Development Report 2022 published by the United Nations Development Programme.Cancer data were stratified by age,gender,and HDI to describe the prevalence of pancreatic cancer globally and in China.Pearson correlation analysis was used to evaluate the correlation of standardized incidence rate(SIR),standardized mortality rate(SMR),and mortality-to-incidence ratio(M/I)with HDI.Results In 2022,the number of pancreatic cancer incident cases worldwide was 510 992,ranking 12th among all cancer incidents,with an SIR of 4.7 per 100 000(ranking 15th).The number of pancreatic cancer deaths globally was 467 409,ranking 6th among all cancer deaths,with an SMR of 4.2 per 100 000(ranking 9th).In China,the number of pancreatic cancer incident cases was 118 672(ranking 10th among all cancer incidents),accounting for 23.22%of the global pancreatic cancer incidents,with an SIR of 4.4 per 100 000(ranking 13rd).The number of pancreatic cancer deaths in China was 106 295(ranking 6th among all cancer deaths),accounting for 22.74%of the global pancreatic cancer deaths,with an SMR of 3.9 per 100 000(ranking 8th).The incidence,mortality,SIR,and SMR in males were higher than those in females both globally and in China.SIR and SMR were positively correlated with HDI(r=0.77 and 0.77,both P＜0.001),while M/I was negatively correlated with HDI(r=-0.43,P＜0.001).The incidence,mortality,SIR and SMR of pancreatic cancer showed an increasing trend with age,and rapidly increased from 45-49 years old.Conclusion The disease burden of pancreatic cancer is serious globally and in China.The incidence and mortality of pancreatic cancer show an upward trend with age,and they are higher in males than in females.HDI is positively correlated with SIR and SMR of pancreatic cancer,while negatively correlated with M/I.

ObjectiveTo investigate the clinical effect and possible mechanism of modified Shenling Baizhu Powder （参苓白术散） and Xiaoluo Pill （消瘰丸） in the treatment of children with adenoid hypertrophy due to spleen deficiency and phlegm accumulation. MethodsOne hundred and thirty children with adenoid hyperplasia due to spleen deficiency and phlegm accumulation were randomly divided into 65 cases each in the observation group and control group. The control group was given mometasone furoate nasal spray， one spray into each nostril， once a day， while the observation group was given modified Shenling Baizhu Powder and Xiaoluo Pill orally， one dose per day， and both groups were treated for 8 months. The pre- and after-treatment electronic nasopharyngoscope scores， specific quality of life survey scale （OSA-18） scores， total TCM symptom scores， serum cysteine leukotrienes （CysLTs）， interleukin 2 （IL-2）， tumor necrosis factor α （TNF-α）， and interleukin 10 （IL-10） levels were compared to determine the clinical efficacy after treatment. ResultsAfter treatment， the electronic nasopharyngoscope scores， OSA-18 scores， total TCM symptom scores， serum CysLTs， IL-2 and TNF-α levels significantly decreased， while IL-10 levels increased in both groups （P＜0.01）. Compared between the two groups after treatment， the electronic nasopharyngoscope score， OSA-18 score， total TCM symptom score， serum CysLTs， IL-2 and TNF-α levels were significantly lower， and the IL-10 level was higher in the observation group than in the control group （P＜0.01）. The total effective rate of the observation group was 95.38% （62/65）， superior to 81.54% （53/65） of the control group （P＜0.05）. ConclusionFor children with adenoid hypertrophy due to spleen deficiency and phlegm accumulation， modified Shenling Baizhu Powder and Xiaoluo Pill can help to improve symptoms， increase quality of life and clinical efficacy， and its mechanism may be related to reducing the inflammatory response.

Quadratus lumborum block(QLB)is a regional anesthesia technique that provides sen-sory and sympathetic nerves block of the unilateral trunk and lower limb by an injection of local anesthetic into the fascia space around the quadratus lumborum.At present,ultrasound-guided QLB is widely used in postoperative analgesia in abdominal and lower limb surgery with satisfied analgesia efficacy.This article will review the anatomical basis,mechanisms,puncture approaches,local anesthetic selection,clinical applica-tion and complications of QLB.

Objective To systematically retrieve,evaluate and integrate evidences about the assessment and management of perioperative pain in patients with acute aortic dissection.Methods PIPOST model was used to identify themes of assessment and management of perioperative pain.The literatures in the themes was systematically searched through the databases of UpToDate,JBI,BMJ Best Practice,practice guide REgistration for trans RAREncy(PREPARE),Guidelines International Network(GIN),National Guideline Clearinghouse(NGC),National Institute for Health and Care Excellence(NICE),Scottish Intercollegiate Guidelines Network(SIGN),New Zealand Guidelines Group(NZGG),Registered Nurses'Association of Ontario(RNAO),Australian Clinical Practice Guidelines(ACPG),American Heart Association(AHA),European Society of Cardiology(ESC),the Chinese Cochrane Center,Medlive,Cochrane library,PubMed,SinoMed,CNKI,Wangfan Data,and VIP.The retrieved literatures were evaluated and the evidences that met the inclusive criteria were extracted from the literatures by researchers who had trained for evidence-based study.Results A total of 17 studies,including 5 guidelines,3 expert consensus,6 systematic reviews and 3 randomised controlled trials were included in this study.Totally,29 pieces of best evidence were extracted in the assessment and management of pain in perioperative patients with acute aortic dissection,including pain assessment,basic principles of pain management,medication intervention strategies of pain management,non-medication intervention strategies of pain management,pain evaluation,education of pain management and organising pain management.Conclusion Evidences in assessment and management of pain in perioperative patients with acute aortic dissection can provide references and guidance for clinical practice.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.